S&C Application

AUTHORIZATION FOR BACKGROUND CHECKS
After carefully reading this Background Check Disclosure and Authorization form, I authorize the Company to order my background report, including investigative consumer reports. I understand that the Company may rely on this authorization
to order additional background reports, including investigative consumer reports, during my employment without asking me for my authorization again as allowed by law.

I also authorize the following agencies and entities to disclose to the Background Check Company and its agents all information about or concerning me, including but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; if applicable, worker’s compensation injuries; all other private and public sector repositories of information; and any other person, organization, or agency with any information about or concerning me. Workers’ compensation information will only be requested in compliance with federal Americans with Disabilities Act and/or any other applicable federal, state or local laws and only after a conditional job offer is made. The information that can be disclosed to the Background Check Company and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses and substance abuse testing.

I agree the Company may rely on this authorization to order background reports, including investigative consumer reports, from companies other than the Background Check Company without asking me for my authorization again
as allowed by law. I also agree that a copy of this form is valid like the signed original. I certify that all of the personal information I provided is true and correct.
Name*

First NameMiddle NameLast Name
Maiden/Other Names

Maiden/Other NamesLast Name
How many years have you used these other names?
Years Used
If you live or work for the Company in California, Minnesota or Oklahoma:
Check this box if you would like a free copy of your background report:

I would like to receive a free copy of my background report, should it be required to have my background checked.
Signature*

Clear
Today's Date*

MonthDayYear
Date
DISCLAIMER
Applicant understands that this is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.

Please complete each section EVEN IF you decide to attach a resume.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Print Name*

First NameLast Name

EMPLOYEE EMERGENCY CONTACT FORM
Employee Name*

First NameLast Name
EMERGENCY CONTACT INFORMATION - PLEASE LIST A FAMILY MEMBER OR FRIEND WHO IS EASILY REACHABLE IN THE EVENT OF AN EMERGENCY
Primary Emergency Contact Name*

First NameLast Name
Relationship*
Primary Emergency Contact Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Emergency Contact Phone Number*
Please enter a valid phone number.
Primary Emergency Contact Alternate Phone Number*
Please enter a valid phone number.
Secondary Emergency Contact Name*

First NameLast Name
Relationship*
Secondary Emergency Contact Address*

Street Address

Street Address Line 2

CityState

Zip Code
Secondary Emergency Contact Phone Number*
Please enter a valid phone number.
Secondary Emergency Contact Alternate Phone Number*
Please enter a valid phone number.

WORK RELEASE AND SAFETY ACKNOWLEDGEMENT
***IT IS YOUR RESPONSIBILITY TO CONTACT YOUR RECRUITER IF YOU ARE RELEASED FROM WORK***
By signing below, you acknowledge that you will take the responsibility to contact your recruiter in the event you are released from employment by your supervisor while under the employ of Scale & Change, LLC. We will do all we can to find you a new assignment that works for all parties involved. If you do not attempt to contact your recruiter, you are acknowledging that you have found additional employment through other means and are not seeking re-employment with Scale & Change, LLC.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Name*

First NameLast Name
ACKNOWLEDGEMENT OF SAFE WORK
Scale & Change, LLC and its clients hold job safety and safe-at-work policies as our top priority. By signing below, you acknowledge that you will adhere to any and all safety training received and job site rules and safety policies reviewed with Scale & Change, LLC and its clients for which you will work. Any unsafe or negligent behavior can and will warrant additional investigation from both Scale & Change, LLC and its clients. You also acknowledge that you will comply with any and all accident/incident related investigations and post-accident drug or toxicology tests for any job site and work-related accidents/incidents for which you are/were
party or privy to.

If you are asked by any supervision to perform tasks for which you are untrained, are not comfortable completing or anything you know to be unsafe, DO NOT PROCEED. Calmly inform the supervisor that you cannot complete this task due as you deem it to be unsafe. If necessary, please escalate this to your recruiter at Scale & Change, LLC and we will step in on your behalf. It is NEVER OK to perform tasks that you know to be unsafe.
Signature*

Clear
Date*

MonthDayYear
Date
Name*

First NameLast Name

BACKGROUND CHECK INFORMATION:
The information requested below is collected solely for the purpose of aiding the Company in running a background check in connection with your application for employment. The employer is requesting that you provide this information to assist in conducting a thorough background check.

For residents of, or for jobs located in Utah, please do NOT provide your date of birth, social security number or driver’s license number until instructed to do so by the Company.
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security Number*
Driver's License Number
Driver's License State of Issue
Please enter the State where your Driver's License is from
Enter Any Other Names Used (including maiden names):
Name

First NameMiddle NameLast Name
Name

First NameMiddle NameLast Name
Name

First NameMiddle NameLast Name
Addresses you have used in within the past seven years? (notify recruiter of any additional as needed)
Present Street Address*

Street Address

Apartment/Suite/Building/Trailer Number

CityState / Province

Postal / Zip Code
Prior Street Address

Street Address

Apartment/Suite/Building/Trailer Number

CityState / Province

Postal / Zip Code
Date you started living at prior address?

MonthDayYear
Date
Date you finished living at prior address?

MonthDayYear
Date
Prior Street Address 2

Street Address

Apartment/Suite/Building/Trailer Number

CityState / Province

Postal / Zip Code
Date you started living at prior address 2?

MonthDayYear
Date
Date you finished living at prior address 2?

MonthDayYear
Date

SUBSTANCE ABUSE AND DRUG TESTING POLICY/TESTING CONSENT
Scale & Change has established the following substance abuse policy:
- It is a violation of company policy for any employee to use, possess, sell, trade, offer for sale, or buy illegal drugs or otherwise engage in the illegal use of drugs on the job.
- It is a violation of company policy for anyone to report to work under the influence of illegal drugs, marijuana or alcohol.
- It is a violation of the company policy for anyone to use prescription drugs illegally. (However, nothing in this policy precludes the appropriate use of legally prescribed medications, so long as their use does not impair job performance.)
I do hereby certify that I have received, read and understand the Scale & Change Substance Abuse and Drug Testing Policy. I further agree to submit to a drug test as
requested as a condition of continued employment. I also understand that failure to
comply with a drug testing request, or a positive drug test result may lead to immediate termination of employment.
Employee Printed Name:*

First NameLast Name
Signature*

Clear
Today's Date*

MonthDayYear
Date
I, First Name* Last Name* , hereby give my consent to authorize my employer known as Scale & Change, LLC, and the testing laboratory designated to conduct tests of any medium deemed necessary, on an ongoing basis, to determine the absence or the presence of illegal substances—Class A or Class B. My employer may request proof that I am taking a controlled substance as directed pursuant to a lawful prescription issued in my name. If requested, I agree to provide such proof within 72 hours. I further understand that a positive test, refusal to authorize this form, refusal to take the test, or failure to produce a specimen, may result in disciplinary action up to and including dismissal in accordance with any local, State, or Federal statute, regulation, and policy.
Signature*

Clear
Print Name*

First NameLast Name
Today's Date*

MonthDayYear
Date

Direct Deposit Authorization Form

Please print and complete ALL the information below.
Name*

First NameLast Name
Address*

Street Address

Apartment/Suite/Building/Trailer Number

CityState / Province

Postal / Zip Code
Please select one of the options to receive payment:*
If Pay Card is selected, please notify your recruiter ASAP that you are in need of a pay card so it can be given to you in office or mailed to you. If Direct Deposit is selected, please continue filling out the information below.
Name of Bank:*
Account Number:*
9-Digit Routing #:*
Amount (Select ONLY ONE)*

$ Amount*% Amount*Entire Paycheck
*If "$ Amount" is selected, please enter that amount here:
NOTE: If this field is left blank, we will assume you want your entire check deposited in the account you have added here.
*If "% Amount" is selected, please enter that percentage here:
Type of Account: (Check One)*

CheckingSavings
Please text your recruiter a photo of a voided check for each bank account to which funds should be deposited (if necessary).
By signing below, Scale & Change is hereby authorized to directly deposit my pay to the account listed above or a company issued pay card. This authorization will remain in effect until I modify or cancel it in writing.
Employee's Signature:*

Clear
Today's Date*

MonthDayYear
Date

Form W-4 - Employee's Withholding Certificate

Department of the Treasury / Internal Revenue Service
- Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
- Give Form W-4 (submitted electronically) to your employer.
- Your withholding is subject to review by the IRS.
Step 1: Personal Information
Name*

First Name and Middle InitialLast Name
Social security number*
Address*

Street Address

Apartment/Suite/Building/Trailer Number

CityState / Province

Postal / Zip Code
Marital Status*

Single or Married filing separatelyMarried filing jointly or Qualifying widow(er)Head of household (Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual)
Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5. If you are EXEMPT from having federal income tax withheld from your salary/wages, please type the words "EXEMPT" to all of the questions in steps 2-4. If you have no dependents, please type "0" in all three spaces for Step 3 below.
Step 2: Multiple Jobs or Spouse Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.
Do only one of the following:
1. Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3 - 4)
2. Use the Multiple Jobs Worksheet and enter the result in Step 4(c) below for roughly accurate withholding
3. If there are only two jobs total, you may check this box. Do the same on Form W-4 of the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld
TIP: To be accurate, submit a 2022 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job.)
Step 3: Claim Depdendents
If your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Multiply the number of qualifying children under age 17 by $2,000*
Remember - type "EXEMPT" if you are exempt from federal withholdings or "0" for no dependents.
Multiply the number of other dependents by $500*
Remember - type "EXEMPT" if you are exempt from federal withholdings or "0" for no dependents.
Total ($)
Step 4: Other Adjustments (optional)
(a) Other income not from jobs($):
If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income.
(b) Deductions($):
If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet and enter the result here.
(c) Extra withholding($):
Enter any additional tax you want withheld each pay period
Step 5: Sign Here
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Today's Date*

MonthDayYear
Date
Employee's Signature*

Clear
This form is not valid unless you sign it.

Construction Staffing & Services

EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

EMPLOYMENT ELIGIBILITY

EDUCATION

AUTHORIZATION FOR BACKGROUND CHECKS

DISCLAIMER

EMPLOYEE EMERGENCY CONTACT FORM

EMERGENCY CONTACT INFORMATION - PLEASE LIST A FAMILY MEMBER OR FRIEND WHO IS EASILY REACHABLE IN THE EVENT OF AN EMERGENCY

WORK RELEASE AND SAFETY ACKNOWLEDGEMENT

IT IS YOUR RESPONSIBILITY TO CONTACT YOUR RECRUITER IF YOU ARE RELEASED FROM WORK

ACKNOWLEDGEMENT OF SAFE WORK

BACKGROUND CHECK INFORMATION:

SUBSTANCE ABUSE AND DRUG TESTING POLICY/TESTING CONSENT

Direct Deposit Authorization Form

Form W-4 - Employee's Withholding Certificate

Step 1: Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Depdendents

Step 4: Other Adjustments (optional)

Step 5: Sign Here

Employment Eligibility Verification

Department of Homeland Security

Section 1. Employee Information and Attestation

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.

List A Document/ID Upload

Construction Staffing & Services

EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

EMPLOYMENT ELIGIBILITY

EDUCATION

AUTHORIZATION FOR BACKGROUND CHECKS

DISCLAIMER

EMPLOYEE EMERGENCY CONTACT FORM

EMERGENCY CONTACT INFORMATION - PLEASE LIST A FAMILY MEMBER OR FRIEND WHO IS EASILY REACHABLE IN THE EVENT OF AN EMERGENCY

WORK RELEASE AND SAFETY ACKNOWLEDGEMENT

***IT IS YOUR RESPONSIBILITY TO CONTACT YOUR RECRUITER IF YOU ARE RELEASED FROM WORK***

ACKNOWLEDGEMENT OF SAFE WORK

BACKGROUND CHECK INFORMATION:

SUBSTANCE ABUSE AND DRUG TESTING POLICY/TESTING CONSENT

Direct Deposit Authorization Form

Form W-4 - Employee's Withholding Certificate

Step 1: Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Depdendents

Step 4: Other Adjustments (optional)

Step 5: Sign Here

Employment Eligibility Verification

Department of Homeland Security

Section 1. Employee Information and Attestation

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.

List A Document/ID Upload

IT IS YOUR RESPONSIBILITY TO CONTACT YOUR RECRUITER IF YOU ARE RELEASED FROM WORK